| Health Net |
| Doryx 150 Mg TbEC (doxycycline hyclate) |
| Drugs for Infections : Antibiotics |
- Quantity Limit: 30 day supply per 1 fill(s).
- ST_APPLIES
- Prior Authorization: Duchenne Muscular Dystrophy (DMD):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 7
Duration: 6 Month(s)
Reauthorization Required: Yes
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